I am the David and Joan Traitel Senior Fellow and member of the Working Group on Health Care Policy at the Hoover Institution of Stanford University. My research includes health care policy and the roles of government versus the free market in access, pricing, and quality of medical care. I served as Professor and Chief of Neuroradiology from 1998 until 2012 at Stanford University Medical Center before my appointment at Hoover.

Obesity: The New 'Just Say No' For 2013

What a holiday gift! No one should be surprised that a new study casting doubt on the harm done by being overweight is being celebrated by the American media. We all know that staying fat is a heckuva lot easier than using willpower to say no to the foods we all love, and who really wants to spend time sweating in the gym or exercising at home instead of sitting on the couch watching television while downing chips and soda? Unfortunately, the recent Journal of the American Medical Association publication analyzing life expectancy correlations to one imperfect calculation of relative weight (BMI, the body mass index) distracts readers all-too-eager to cling to its implications that being chubby is actually better.

The deleterious medical consequences of being overweight or obese should not even be debated at this point, because the findings are incontrovertible.Peeters found a six years reduction in life expectancy at age forty for obese men, and seven years for obese women, compared to non-obese people. The OECD estimates that the lifespan of an obese person is “up to 8-10 years shorter (for a BMI of 40-45) than that of a normal-weight person” – matching the loss of longevity seen in cigarette smokers. According to the OECD, for every 15 kilograms of excess weight, the risk of death increases by about 30%. A Harvard study in March 2012 showed that if adults become non-obese by 2020, the life expectancy in the US would increase by almost four years from that fact alone. The study went further to point out that the entire positive impact of declining smoking rates on American health would be completely overtaken – even reversed – by obesity if current trends continued.

The recent JAMA study implying that being overweight has longer life expectancy than being thin is not simply counterintuitive.Tragically, its authors give the public and the naïve lay media the excuse to suddenly disregard incontrovertible evidence found in hundreds of peer-reviewed publications for decades about the severely harmful effects of obesity on health. Beyond its impact on life expectancy, obesity and being overweight correlate to innumerable serious diseases and have overwhelming effects detrimental to quality of life. A long but incomplete list of serious diseases with increased incidence in obese and overweight adults and children includes diabetes mellitus, type 2; hypertension (high blood pressure); cardiovascular disease (heart disease); stroke; cancer of the prostate, colon, breast, uterus, cervix, kidney, and gallbladder; end-stage renal disease (chronic kidney disease) requiring dialysis or transplant; sleep apnea; gallbladder disease and gallstones; hip arthritis and gout; liver disease; pregnancy complications; complications from surgery; infertility; and Alzheimer’s Disease.

Even more worrisome is the fact that obesity rates are rising not only in adults but in children. Since obesity is estimated to show a lag time of about 25 years before more complete effects on premature death and disease are seen, public health experts predict an enormous impact on world-wide health and life expectancy in the future. For example, a strong link between childhood obesity and death from heart disease decades later was recently found, and there is abundant evidence that obesity is the culprit of the shocking increase in diabetes in children. Will this be the first generation in American history with a shorter life expectancy than their parents?

In an economic context, the burden of obesity to the U.S. health care system and U.S. taxpayers is at crisis levels and will only increase. Extra medical care for obesity comprises from 5 to 10% of total U.S. health care costs, half of which Medicare and Medicaid finances. Due to its high prevalence and its associations with multiple chronic diseases, worse treatment results and complications from even the best medical and surgical care, increased levels of disability, absenteeism from work, and premature death, the total societal costs from obesity in the U.S. every year exceed $215 billion. “Keeping obesity rates level could yield a savings of nearly $550 billion in medical expenditures over the next two decades,” recently projected Eric Finkelstein of Duke University.

Meanwhile, a different survey just published from the Associated Press-NORC Center for Public Affairs Research reported that 88 percent of Americans believe that individuals themselves shoulder a large or very large responsibility to solve the country’s obesity problem. Unfortunately, the same survey showed some significant denial about the seriousness of the problem. Among women, eighty-one percent say that overweight and obesity are serious health problems, and only sixty-nine percent of men agreed. Now is certainly not the time to minimize the tremendous health and economic burden from being overweight or obese.

Solving this nation’s most pressing health problem is more than any other single factor critically dependent on individual responsibility. While the AP-NORC survey underscored awareness of personal responsibility in a general sense, the list of nine options selected as possible causes of obesity shockingly failed to include the most obvious culprit of all –overeating! Check out what’s on the table in front of the fat people the next time you walk by a restaurant – feel free to let me know how often it is only a half-sandwich, a salad, or some other healthful alternative to what I usually notice when I take a casual look.

And just like smoking and its second-hand health effects, second-hand fat should be a serious societal concern. Studies show that obese and overweight parents have a strong influence on their children, generating a second-hand obesity and all of its health problems. Can there be any serious doubt how influential parents are on their children’s dietary and exercise habits, whether in directly choosing what foods and portions to serve at meals or in serving as role models for fitness? And beyond influence, can anyone deny the profound responsibility of parents to ensure that children do not develop such disastrous personal habits as overeating with reckless abandon?

Even though the overwhelming majority of Americans do seem to understand where the responsibility lies, personal responsibility has not exactly been a fundamental message of this administration. That is indeed a shame, for there is no doubt that President Obama, like all presidents before him, commands unique power in the eyes of the American citizenry. Originally coined over 100 years ago by Theodore Roosevelt in talking about the power of the presidency, the bully pulpit of the White House is still probably the most potent of all positions of prestige and visibility from which to influence the public.

While heavy-handed government regulations and arbitrary “food censorship” limits are totally inappropriate, the government can heighten awareness about the problem and the most important solution. Although criticized as being overly simplistic, public awareness about drug abuse increased from Nancy Reagan’s “just say no” campaign, and that type of message about the importance of individual lifestyle decisions like overeating fits the test of common sense, even in our current era of victimization and entitlement. To her credit, First Lady Michelle Obama has been a strong proponent of health and nutrition. But the message about individual responsibility in obesity and the power of “just saying no” to being fat has not been adequately emphasized, especially to America’s children. In an administration where the nation’s Surgeon General is obese, maybe our President needs to reconsider the enormous power of his bully pulpit about obesity, just like he undoubtedly understood when he quit smoking in public.

Since studies of the 1960’s clarified the impact of cigarette smoking on health, smoking became an object of concerted public health efforts and smokers were ostracized with great effect on the incidence of smoking in the United States. Yet the discussion of obesity is held to a different standard, considered not only politically incorrect but even labeled as discrimination and prejudice. It is notable that U.S. trends in smoking and obesity have been in opposite directions; over the past fifteen years, smoking rates have declined by 20 percent, while obesity rates have increased by 48 percent. In a society where the most gruesome images are put forth to discourage smoking, and are effective in doing so, there should be no hesitancy to start a similar campaign that uses graphic advertising to illustrate the consequences of being overweight.

A first important step is to openly admit and emphasize that increasing rates of obesity are primarily due to overeating coupled with a lack of sufficient exercise. Although the causes of obesity are undoubtedly complex, only a limited number of cases are primarily due to genetics. Genetics of populations change far too slowly and cannot explain the recent sharp increase in obesity rates or the pattern of increasing prevalence of obesity first and most severe in the U.S. and later in the world’s economically developing countries.

Obesity is a uniquely urgent crisis in the United States. Americans are the fattest in the world, and the future is bleak. It is even more sobering to realize that obesity is estimated to show a lag time of about 25 years before its total effect on premature death and disease is seen. Given the higher rates and predicted trends of obesity in American children and adults, health gains over the past century could be wiped out by the deleterious effects on disease outcomes and life expectancy that will be seen for decades to come if the current situation is not remedied. No magic medicine or easy cure is apparent, but perhaps the most effective message that government can send is to hold individuals accountable for their own personal lifestyle decisions. Health care reform in the U.S. urgently needs to embrace a new era of personal responsibility, and obesity should be the highest priority.

Scott W. Atlas, MD is the David and Joan Traitel Senior Fellow at the Hoover Institution, Stanford University, and author of the book In Excellent Health: Setting the Record Straight on America’s Health Care (Hoover Press, 2011).

Post Your Comment

Post Your Reply

Forbes writers have the ability to call out member comments they find particularly interesting. Called-out comments are highlighted across the Forbes network. You'll be notified if your comment is called out.